Neuroimaging clinics of North America
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Childhood intracranial aneurysms differ from those in the adult population in incidence and gender prevalence, cause, location, and clinical presentation. Endovascular treatment of pediatric aneurysms is the suggested approach because it offers both reconstructive and deconstructive techniques and a better clinical outcome compared with surgery; however, the long-term durability of endovascular treatment is still questionable, therefore long-term clinical and imaging follow-up is necessary. The clinical presentation, diagnosis, and treatment of intracranial aneurysms in children are discussed, and data from endovascular treatments are presented.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewSpontaneous cervical and cerebral arterial dissections: diagnosis and management.
Arterial dissections of head and neck arteries were first identified pathologically in the 1950s, but not until the 1970s and the 1980s did they begin to be widely recognized as a clinical entity. Carotid and vertebral artery dissections account for only 2% of all ischemic strokes, but they account for approximately 20% of thromboembolic strokes in patients younger than 45 years. The cause of supra-aortic dissections can be either spontaneous or traumatic. This article addresses spontaneous cervical and cerebral artery dissections.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral vasospasm: vasodilators and angioplasty.
Cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is a delayed, reversible narrowing of the intracranial vasculature that occurs most commonly 4 to 14 days after aneurysmal SAH and can lead to permanent ischemic injury. Angiographic spasm occurs in up to 70% of patients following SAH, and approximately half become symptomatic. Estimates of patients who are disabled by vasospasm, or die because of it, range from 5% to 9%, with vasospasm accounting for 12% to 17% of all fatalities or cases of disability after SAH. This article discusses the multiple medical and endovascular therapies used to prevent or treat vasospasm.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of intracranial atherosclerotic disease.
Stroke is the third leading cause of death in the United States. Intracranial atherosclerotic disease plays a role in cerebrovascular accidents, with well-characterized modifiable and nonmodifiable risk factors. ⋯ Initial reports on the results of stent placement for symptomatic high-grade intracranial atherosclerotic disease were initially encouraging. However, debate remains as to the optimal treatment of symptomatic intracranial atherosclerotic disease.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral arteriovenous malformations.
Treatment of arteriovenous malformations of the central nervous system requires a multidisciplinary approach with input from vascular neurosurgeons, endovascular interventionalists, and radiation oncologists. Treatment paradigms based on a thorough understanding of the natural history of the lesion and the cumulative risks of multimodality treatment maximize the likelihood of a positive outcome. This article outlines the role of endovascular embolization in the treatment of arteriovenous malformations with specific emphasis on decision making during treatment planning. Technical considerations when treating arteriovenous malformations are discussed, including the choice of embolic agents, potential intraprocedural and periprocedural complications, and postprocedural management of patients.